Multiple births may not have a simple solution

This week's BioNews includes news of research from Sweden which shows a higher rate of complications in the births and subsequent development of children born as a result of in vitro fertilisation. The authors of the research paper state that this is caused not by IVF itself, but by the increased number of multiple births which, in turn, lead to more premature births and lower birth weights. The answer seems obvious: reduce the number of multiple births by transferring fewer embryos to the womb in each treatment cycle. But in the discussion of multiple births in IVF, a misperception about patients has gone unnoticed. Patients have often been characterised as people so desperate to have a child that they will put themselves and their prospective children at any risk in order to do so.

Couples undergoing IVF are confronted with a number of different issues. One of the highest priorities, of course, is a successful pregnancy. This is understandable since they have waited a long time to conceive and have gone through much more than most couples in their quest for parenthood. But wanting a child is not the only motivation for seeking a pregnancy at the first IVF attempt. IVF treatment is expensive. Those people who are lucky enough to secure state-funded treatment may only have one or two treatment cycles on offer to them. And few of those who are denied state-funded treatment can afford to have repeated cycles of IVF.

Even if they could afford multiple treatment cycles, IVF is not something which patients enter into lightly. Each cycle not only requires money, but also time and physical and emotional endurance. The age of IVF patients may also be against them. People in this situation will want to have a successful treatment cycle as soon as possible so as to avoid the lowered chance of success which comes with advanced maternal age.

None of this means that efforts should not be made to reduce the incidence of multiple births in IVF treatment. Patients are often unaware of the risk of a multiple pregnancy and the medical complications that they often bring. Clinicians sometimes suggest that patients are too preoccupied with getting pregnant that they ignore warnings about twins and triplets. But if this is the case, clinicians should make sure that patients do understand the risk. Whether doctors need to be forced to limit the number of embryos transferred to two, is a controversial point. But continued public discussion of the issues can only help patients become more aware of the issues prior to their first appointment. As far as the publication of clinic success rates goes, perhaps prospective patients should be given two statistics: the success rate and the multiple pregnancy rate.